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Whelan, 49, is a former Marine arrested while on vacation in Russia and charged with being a spy — something he and his family deny and the State Department has cast doubt on.

In court Friday, Whelan said he had been dragged by prison guards, exacerbating a hernia in his groin. His lawyer Vladimir Zherebenkov said prison doctors examined Whelan and agreed he will need to be operated on after it was recently aggravated.

An injury to his left shoulder has also been “deteriorating, not improving, and could lead to emergency surgery,” his family said last week.

Tatyana Makeyeva/Reuters

Paul Whelan is escorted inside a court building in Moscow, Aug. 23, 2019.

During the hearing, Whelan read a statement to the press as court officials tried to shout him down and remove the press from the room: “I’m innocent of any charges, all of this is political kidnapping. No crime ever occurred. There is no evidence of a crime. This is a set-up. Isolation continues in order to force a false confession. Medical care for injuries inflicted by the FSB in prison has been refused. My human rights complaints have been resulting in retaliation … Full consular access is being denied. As a political prisoner, I’m asking the government to –”

Journalists and cameras were removed from the room before he could finish.

The judge ruled Friday to prolong his detention for at least two more months until October 29. Whelan accused her and the prosecutor of being biased and working with authorities from the FSB, Russia’s domestic security agency, to keep him in detention.

Whelan’s lawyer Zherebenkov said he had not been able to visit Whelan for more than a month. Despite Whelan’s statement that “full” consular access was being denied, Zherebenkov also said a Canadian official visited him Thursday, and a U.S. official would next week.

In addition to being a U.S. citizen, Whelan has Canadian, British, and Irish passports. U.S. embassy officials were in the courtroom Friday for his hearing.

Yuri Kochetkov/EPA via Shutterstock, FILE

U.S. citizen Paul Whelan is pictured in court prior to a hearing at the Moscow City Court in Moscow, June 20, 2019.

Andrea Kalan, spokesperson for the U.S. embassy in Moscow, tweeted that they’ve asked the Foreign Ministry “for immediate consular access to meet with Paul Whelan to speak with him about his serious health allegations.”

A State Department spokesperson later told ABC News they were “aware” of the judge’s decision and “continue to urge the Russian government to guarantee a fair and transparent judicial process without undue delay.”

“We take allegations of mistreatment seriously and are deeply concerned with Mr. Whelan’s allegation of continuing mistreatment at his most recent hearing,” the spokesperson added, adding they have previously protested to the Foreign Ministry and asked them to investigate and ensure Whelan’s safety.

There was no comment on Whelan’s accusations of a “set-up” by the court and prosecutor, although the spokesperson noted “our concerns regarding the lack of evidence that has been presented.”

The judge denied Whelan’s motion to disqualify the prosecutor, calling it “unwarranted,” and requested an ambulance to evaluate his medical condition.

AP Photo/Susan Walsh

President Donald Trump, right, meets with Russian President Vladimir Putin during a bilateral meeting on the sidelines of the G-20 summit in Osaka, Japan, Friday, June 28, 2019.

An ambulance arrived at the court, but parademics said Whelan did not require hospitalization. He was returned to the notorious Lefortovo prison in Moscow.

Some critics say the Trump administration has done little to pressure Moscow to present evidence against Whelan or release him.

President Trump himself repeatedly tweeted about rapper A$AP Rocky’s case after he was arrested in Sweden, even calling the Swedish Prime Minister and sending Special Envoy for Hostage Affairs Robert O’Brien to attend his trial. Earlier this month, Rocky was found guilty of assault during a Stockholm fight and given a two-year suspended sentence.

The families of other American citizens detained abroad, including the wife of Xiyue Wang, a Princeton PhD student held by Iran, have urged Trump to intervene as strongly in their cases.

The Trump administration has secured the release of several high-profile American cases, including Pastor Andrew Brunson from Turkey, aid worker Aya Hijazi from Egypt, and three U.S. citizens held by North Korea, Tony Kim, Kim Dong Chul, and Kim Hak Song.